What They Have. What We Have. What They Could Have

If you haven’t read yesterday’s post, please do so, and pay especial attention to the comments, where James DiBenedetto and I engage in some rather heated rhetoric. I hope we both got to say what we wanted to say, but this morning I thought of one more issue I needed to address, and I think it deserves its own post here.

In his first comment to my blog yesterday, Jim says:

And when there is a Republican President again, who appoints conservatives to the panels and boards that will set medical policies for America thanks to this bill, and they make decisions that liberals find unpalatable (say, on abortion), I will remind them that it was they who gave this power to the government, and I will say, as loudly and obnoxiously as I can, “We told you so!”

Jim makes a number of assumptions here, first being that this system is in any way different or worse than the insurance company panels and boards which currently set medical policies for Americans, at times determining whether or not a medical procedure will be funded based on the cost of keeping individuals alive. More importantly, he also appears to assume that Americans will be bound only to those medical policies that a supposed government panel will impose, and that Americans would have no opportunity to go beyond these strictures. He implies that certain procedures not covered by a government insurance plan just wouldn’t happen.

This isn’t the case here in Canada.

First of all, what we have in Canada is not a socialized medical system. What we have is a single-payer government-run insurance system. The government sets its guidelines in terms of what medical procedures it will or won’t pay for. It’s little different than a massive insurance company, except that the entire population is pooled, and the thing operates as a massive non-profit. Everything else outside of this system is privately run. Doctor offices are private businesses.

I am, for instance, entitled to a free annual physical check-up by my family physician, as is my wife. I’m also entitled to visit my physician by appointment, for free, to examine any medical question. This includes but isn’t limited to colds that don’t go away after a week, suspicious rashes, and so on. The system as it stands gives our family physicians considerable leeway as to what medical procedures the government (through our taxes) is called upon to pay for, including a variety of medical tests — whatever my doctor deems medically necessary.

And, here’s the thing: I can choose to go beyond what my government covers, if I decide to pay for it. Elective surgeries are not covered by our government-run insurance program, but they still happen every day. In other words, the system that Americans already work with continues to exist in Canada outside of the system that the Canadian government pays for. (Correction: “cosmetic” surgeries aren’t covered. “Elective” surgeries are an entirely different thing; they don’t mean “unnecessary”; rather, they refer to “non-urgent” or “non-emergency”. Plenty of these are covered under our health insurance plans. Thanks to Josh for the correction in the comments below)

Jim brings up a hypothetical situation where government panels could potentially restrict abortions thanks to the powers supplied by these medical reforms, but here in Canada truly elective abortions are not covered under our health care plans. They are, by definition, elective surgery, and so are performed at clinics where patients pay out of pocket. If a doctor determines that an abortion is medically necessary for the maintenance of a woman’s physical or emotional health, then that’s different — the government has to pay for it — but abortion on demand is an elective procedure that people pay for like dentistry. (And, again, correction: certain abortions beyond medically necessary are covered under certain provincial plans; it depends, really, on the province — some of whom also provide some coverage of dental costs in some situations, as I recall. That’s a bit of an oops on my part and I apologize. But the point I’m making is that it’s that it’s possible to pay for certain medical services beyond what the government funds. Lack of funding does not necessarily equate to banning.)

As an aside, dentistry and optometry are not covered by our government health plans; at least, not here in Ontario. They continue to operate privately, covered by private insurance programs. And this is fine because these situations are rarely life-threatening. And if they are life-threatening, the family physician can be contacted, call in various specialists, and order medical procedures done. Now, I’ve heard anecdotal evidence of some individuals without dental insurance allowing an abscess to grow to the point where it breaks their jaw, so that the medical procedure would be covered by our medical system, but I’ve found no credible evidence that this has actually happened, and such reports have come less and less as the days have gone on.

Continuing this aside, prescriptions are also privately covered, although here there is some talk about a national pharmicare plan — something akin to how the Obama medical reforms “closes the donut hole” — as many individuals find the cost of prescriptions onerous if they don’t have a job with its associated drug plan. Although, you’ll remember how many American seniors ran to Canada for their drugs? That’s because our brand name drugs are less expensive up here, and we achieved this back in the early 1990s when our Conservative government — tip of the hat to Mulroney, here — negotiated a deal with the multi-national pharmaceutical companies, extending their patent protection from generic copies in exchange for lower prices. Aside ends.

The point is, just because something isn’t funded by the Canadian medical system doesn’t mean that it doesn’t exist. And this would be the case in America. If the American medical system doesn’t pay for a particular procedure, people can still pay to have that procedure done. If Jim is arguing that the reforms will allow the government to block all access to abortion, he’s dead wrong. The only way the government can physically prevent individuals from seeking an abortion is if they criminalize it, and that’s an entirely different debate. And as for government policies cutting government coverage of medically necessary abortion, I would agree that such policies would be cruel. But it is no more cruel than the current situation where medically necessary procedures are blocked due to profitability concerns. And at least if the government were intent on being this cruel, voters would have the opportunity to hold their politicians accountable every second November. How do voters hold the powerful insurance companies to account? One way is through government regulation. Which is what passed this past Sunday.

The test for me as to whether or not the proposed new system is a good system is whether or not all medically necessary procedures are covered. The goal should be that nobody is forced into bankruptcy as a result of onerous medical costs incurred due to serious medical conditions. Given that medical costs are at the root of most of the personal bankruptcies in the United States, this tells me that the status quo abjectly fails this test, and that change is needed.

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